The objective of this study was to investigate the safety of repeated parenteral ketamine for depression. An electronic survey inquiring about the frequency of adverse events was distributed to providers of parenteral ketamine for depression. In addition, the investigators conducted a search of published studies describing six or more repeated parenteral ketamine treatments administered to individuals for depression, and extracted reported adverse events. The survey was sent to 69 providers, of which 36 responded (52% response rate); after eliminating those that were incomplete, 27 were included in the analysis. The providers in the analysis collectively reported treating 6630 patients with parenteral ketamine for depression, one-third of whom received more than 10 treatments. Only 0.7% of patients experienced an adverse effect that required discontinuation of ketamine. Psychological distress during the treatment was the most frequent cause. Other adverse events were extremely rare (such as bladder dysfunction (0.1%), cognitive decline (0.03%) and psychotic symptoms (0.03%)). Among the 20 published reports of repeated parenteral ketamine treatments, rates of significant adverse events resulting in discontinuation were low (1.2%). The rate of adverse effects reported in the survey and the published literature is low, and suggests that long-term treatment of depression with ketamine is reasonably safe.
Schizophrenia (SZ) is a serious mental illness and neuropsychiatric brain disorder with behavioral symptoms that include hallucinations, delusions, disorganized behavior, and cognitive impairment. Regulation of such behaviors requires utilization of neurotransmitters released to mediate cell-cell communication which are essential to brain functions in health and disease. We hypothesized that SZ may involve dysregulation of neurotransmitters secreted from neurons. To gain an understanding of human SZ, induced neurons (iNs) were derived from SZ patients and healthy control subjects to investigate peptide neurotransmitters, known as neuropeptides, which represent the major class of transmitters. The iNs were subjected to depolarization by high KCl in the culture medium and the secreted neuropeptides were identified and quantitated by nano-LC-MS/MS tandem mass spectrometry. Several neuropeptides were identified from schizophrenia patient-derived neurons, including chromogranin B (CHGB), neurotensin, and natriuretic peptide. Focusing on the main secreted CHGB neuropeptides, results revealed differences in SZ iNs compared to control iN neurons. Lower numbers of distinct CHGB peptides were found in the SZ secretion media compared to controls. Mapping of the peptides to the CHGB precursor revealed peptides unique to either SZ or control, and peptides common to both conditions. Also, the iNs secreted neuropeptides under both KCl and basal (no KCl) conditions. These findings are consistent with reports that chromogranin B levels are reduced in the cerebrospinal fluid and specific brain regions of SZ patients. These findings suggest that iNs derived from SZ patients can model the decreased CHGB neuropeptides observed in human SZ.
On 29 June 2018, a team of chefs from the At-Sunrice GlobalChef Academy created and served a complete seven-course Note by Note Chinese dinner to two different seatings at the At-Sunrice GlobalChef Academy. For the first time in Singapore, a Note by Note menu was created and served.
Faculty workload is difficult to delineate and quantify equitably because of the various factors and diverse roles that define faculty positions. This is especially true in health professions education, including pharmacy. Nonetheless, ensuring fair and transparent distribution of faculty workload is necessary for equity and engagement of the faculty workforce. While it is impossible to develop a uniform policy for all faculty, there can be a guide for how workload is developed and measured, especially for promotion or awarding of tenure, focusing on equity and transparency. Developing clear definitions of workload, setting mutually agreed expectations, and sharing transparent workload assignments and distribution within the institution may be needed. It is imperative to discuss an optimal policy for equitable and transparent workload in each institution and in academic pharmacy as a whole; a lack of this effort can create undue hardship for faculty, decrease productivity, potentially worsen faculty morale, and ultimately impair faculty retention.
Abstract Purpose: SENTI-301A is a novel off-the-shelf CAR-NK product candidate that uses gene circuits to enhance NK cell persistence and targeted cytotoxicity to address unmet needs in GPC3 expressing solid tumors such as hepatocellular carcinomas (HCC). Experimental procedures: SENTI-301A is a Multi-Armed, targeted chimeric antigen receptor (CAR) NK cell preclinical product candidate with a GPC3 CAR and calibrated-release interleukin-15 (crIL-15) engineered onto allogeneic healthy adult peripheral blood NK cells. The activating CAR is designed to target GPC3, an antigen overexpressed in several cancers, such as HCC. crIL-15 is a unique technology attaching wild type IL-15 to the membrane via a linker that can be cleaved by a ubiquitous protease. This results in membrane-bound and secreted IL-15 to provide both autocrine support to the CAR NK cells, and paracrine stimulation to other surrounding immune cells in the tumor microenvironment for enhanced antitumor response. Results: SENTI-301A exhibited increased crIL-15-driven survival and expansion (>30 days) without exogenous cytokine support compared to unengineered NK cells (~6 days). SENTI-301A also showed significantly higher in vitro cytotoxic activity (~20%) against GPC3 expressing cell lines compared to isogenic cells lacking the antigen, indicating CAR-mediated activation and antigen specificity. SENTI-301A also showed significant tumor killing function, IFNg, and Granzyme-B production, when co-cultured with HCC and other GPC3 expressing tumor cell lines at different effector:target ratios. SENTI-301A maintained the antitumor function in the presence of full-length soluble GPC3, reducing the risk of competition from shedding GPC3 with surface GPC3 for CAR-NK cell binding. In HCC mouse xenograft models, SENTI-301A showed NK cells tumor infiltration, and displayed enhanced persistence, antitumor function and increased median survival (p< 0.01), in comparison to unengineered NK cells. As next steps, the potential positive impact of immune checkpoint inhibitors (CPIs) in combination with SENTI-301A to enhance anticancer function is being assessed. Conclusions: SENTI-301A is a novel off-the-shelf preclinical CAR-NK cell therapy candidate that targets GPC3-expressing tumors in an antigen-specific manner and exhibits increased persistence via crIL-15. We are exploring the potential synergy between SENTI-301A and CPIs to enhance the existing antitumor functions of SENTI-301A. SENTI-301A is planned for clinical development with an investigational new drug application (IND) expected in 2023. Citation Format: Marcela Guzman Ayala, Deepika Kaveri, Enping Hong, Elizabeth Leitner, Priscilla Wong, Ronni Ponek, Lawrence Naitmazi, Pearley Chinta, Wesley Gorman, Mengxi Tian, Niran Almudhfar, Kelly Lee, Nicholas Frankel, Alba Gonzalez Junca, Russell Gordley, Philip Lee, Timothy Lu, Kanya Rajangam. SENTI-301A, an off-the-shelf multi-armed preclinical CAR-NK cell therapy, for the treatment of GPC3 expressing tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2905.
Abstract Background Studies estimate that 30%–50% of antibiotics prescribed for hospitalized patients are inappropriate, but pediatric data are limited. Characterization of inappropriate prescribing practices for children is needed to guide pediatric antimicrobial stewardship. Methods Cross-sectional analysis of antibiotic prescribing at 32 children’s hospitals in the United States. Subjects included hospitalized children with ≥ 1 antibiotic order at 8:00 am on 1 day per calendar quarter, over 6 quarters (quarter 3 2016–quarter 4 2017). Antimicrobial stewardship program (ASP) physicians and/or pharmacists used a standardized survey to collect data on antibiotic orders and evaluate appropriateness. The primary outcome was the percentage of antibiotics prescribed for infectious use that were classified as suboptimal, defined as inappropriate or needing modification. Results Of 34 927 children hospitalized on survey days, 12 213 (35.0%) had ≥ 1 active antibiotic order. Among 11 784 patients receiving antibiotics for infectious use, 25.9% were prescribed ≥ 1 suboptimal antibiotic. Of the 17 110 antibiotic orders prescribed for infectious use, 21.0% were considered suboptimal. Most common reasons for inappropriate use were bug–drug mismatch (27.7%), surgical prophylaxis > 24 hours (17.7%), overly broad empiric therapy (11.2%), and unnecessary treatment (11.0%). The majority of recommended modifications were to stop (44.7%) or narrow (19.7%) the drug. ASPs would not have routinely reviewed 46.1% of suboptimal orders. Conclusions Across 32 children’s hospitals, approximately 1 in 3 hospitalized children are receiving 1 or more antibiotics at any given time. One-quarter of these children are receiving suboptimal therapy, and nearly half of suboptimal use is not captured by current ASP practices.
